"Across the country, public health needs to double down on data, and on interoperable, secure IT solutions such as data warehousing and better linkages between our siloed data sets," said Monica Bharel, MD, MPH, Massachusetts state health commissioner.

Subcommittee chair Tim Murphy (R-Pa.) noted in his opening remarks that in the time that had passed since the subcommittee's hearing on the subject earlier in the month, about 2,400 Americans had died from drug overdoses -- mostly from opioid use.

"The size of this problem and the need for a new paradigm of treatment can't be understated," Murphy said, noting that he and the subcommittee's ranking member, Rep. Diana DeGette (D-Colo.) had identified 15 different areas to target for legislative reform.

Adams said three areas need improvement: "We need to stop the flow of opioids into communities, we need to deal with the personal and public health consequences of communities with an overflow of opioids and of people engaging in high-risk activities, and we need to create an outlet for those seeking recovery from substance use disorders."

The last issue is important because "If people don't have help they'll increasingly turn to and stay on prescription drugs, a lesson we learned in Scott County," Adams said. He was referring to an HIV epidemic in that county, with 158 confirmed cases -- 95% of which are related to injection drug use -- and an 88% rate of co-infection with the hepatitis C virus.

Mark Stringer, director for behavioral health at the Missouri Department of Mental Health, agreed. "If there's a theme running through the messages this morning, it's that access to treatment and recovery services is essential to addressing this problem," he said. "On this very day in Missouri, nearly 3,000 people are on a waiting list for substance use treatment services."

"What's truly sad about this," he continued, "is that often a person seeks treatment after a life-altering event -- a run-in with the law, a problem at work, some type of illness, or an overdose. So every name on a waiting list is a potential tragedy for the individual, the family, and the community."

Physicians need to be part of the solution, several speakers said. In Indiana, all opioid prescribers are encouraged to take courses in pain management, said Adams.

He pointed out that requiring education for physicians only goes so far, since "the majority of people doing the prescribing of opioids aren't physicians, so you can do all you want with docs, but if you're not taking care of everyone prescribing opioids, you're not going to solve the problem."

In Massachusetts, all physicians are required to take pain management training courses, but most medical schools don't require training in this area, Bharel said, adding that "at the federal level, accreditation could be looked at to acquire some of that training."

In Colorado, some of the training is tied to malpractice premium reduction, "so a way around additional requirements is 'You can save some money on your malpractice insurance if you take this training,'" said Larry Wolk, MD, MSPH, chief medical officer at the Colorado Department of Public Health and Environment.

Mandatory PDMP participation was another issue discussed at the hearing. Adams, of Indiana, Bharel, of Massachusetts, and Wolk, of Colorado, all said their states require physicians to sign up for the PDMP at the time of their acquiring a DEA license to prescribe controlled substances.

One thing that has helped, at least in Indiana, has been the state's rules for opioid prescribing. "We've seen a 10% drop in overdoses since we instituted the prescribing rules," which apply to anyone who prescribes more than 60 opioid pills per month to a patient, or more than 15 mg/day, Adams noted. If the patient is receiving more than that "you have to bring the patient in face-to-face [for a visit] and consider referring them" for substance use treatment.

The rules also allow for doctors to "fire" patients who aren't following their treatment plan, a provision that has had tremendous success, he said.

In terms of overdose treatment, Bharel said Massachusetts has had good results with naloxone (Narcan) for reversing overdoses. Since 2007, the state has distributed 35,000 doses of the drug and has documented 5,000 overdose reversals, she said.

Adams encouraged subcommittee members to look at a Senate bill, the Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015 -- co-sponsored by Kelly Ayotte (R-N.H.) and Joe Donnelly (D-Ind.) -- which includes support for various abuse prevention and enforcement measures. DeGette told MedPage Today after the hearing that while members will be looking at that bill, they will also focus on developing their own legislation and plan to meet after the House's Memorial Day recess ends to discuss it.

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